A Virtual Resiliency Treatment for Parents of Children with Learning - PowerPoint PPT Presentation

A Virtual Resiliency Treatment for Parents of Children with Learning and Attentional Disabilities (LAD) and Autism Spectrum Disorders (ASD) Elyse R. Park, Ph.D., MPH Associate Professor in Psychiatry, HMS Karen A. Kuhlthau, Ph.D. Associate Professor of Pediatrics, HMS MARINO HEALTH FOUNDATION INC

Questions for Discussion  Gathering input/feedback on study results  Ideas for implementation trial (e.g., clinician or peer delivered)  Identifying funders  Identifying organizational partners, particularly for parent referrals

Benson-Henry Institute for Mind Body Medicine  The Benson-Henry Institute (BHI) is an independent thematic center at MGH  Clinical practice, research, and education  Focused on mind-body medical techniques, including: mediation, yoga, tai chi, etc.

Stress Response  Walter B. Cannon described the “fight or flight” response to stress, a consistent set of physiologic changes that occur when individuals are exposed to stress.  The stress response prepares the body for a physical reaction to a real threat – to fight or to flee. Photo by:http://www.neuralconnections.net/2014/07/stressappraisal- and-adaptation.html Photo by: Aoife Mcloughlin http://elt-connect.com/fun-with-word-stress/ Photo by: www.gabankruptcylawyersnetwork.com

Normal vs. Maladaptive Responses to Stress Arousal Reaction Allostatic Load Allostasis stressor stressor stressor Adaptive from McEwan B, Neuropsychopharmacology, 2000

Resilience?  The ability to adapt successfully in the face of stress and adversity.  The capacity and dynamic process of adaptively overcoming stress and adversity while maintaining normal psychological and physical functioning (Wu et al., 2013)  Characteristics that promote resiliency may help to buffer parents from the stress related to caring for a child with LAD or ASD

Diathesis-Stress Model

BHI Resiliency Perspective Resiliency is characterized by the ability to:  Adapt to stress by eliciting the RR  Generate adaptive thoughts  Engage in healthy lifestyle behaviors  Experience pleasure and appreciation  Engage in empathic and pleasant behaviors

Relaxation Response Resiliency Program (3RP) Core Elements  Skills building in eliciting the RR  Decreasing stress reactivity by increasing awareness of stress response components  Practicing adaptive strategies:  Positive Perspectives/creativity  Healthy lifestyle behaviors  Social connectedness  Reexamination and coping/humor

RR Elicitation Adaptive Strategies Stress Awareness

Relaxation Response

Component 1: RR elicitation goals  Achieve an ongoing RR practice  Identify which RR elicitation strategy is best for you  Feel skillful at eliciting the RR  Experience the RR “opening” effect

RR Elicitation Mindfulness Eating Use all of your Slow down, sense to notice pause between what eating is like. bites. Take time to savor. Imagine you are describing the food to someone Notice how eating who has never this way is different seen, smelled, from how you touched or tasted normally eat. it. B

Component 2: Decrease stress reactivity  Identify your stress warning signs  Build your stress coping resources  Proactively develop your positive cognitions, pleasant emotions and health promoting behaviors

Exercise: Energy Battery

Component 3: Adaptive Strategies  Reappraisal & Coping  Positive Perspectives  Social Connectedness  Lifestyle Behaviors

Types of Social Support  Emotional  Informational  Tangible  Self-esteem/affirmation  Belonging

Virtual Resiliency Treatment for Parents of Children with Learning and Attentional Disabilities (LAD) or Autism Spectrum Disorders (ASD): Two Randomized Pilot Trials

Why a Virtual Resiliency Program for Parents of Children with LADs or ASD?  Parents of children with LAD and ASD are vulnerable to high levels of distress, and subsequent health risks  A comprehensive treatment program focused on the needs of parents of children with LADs or ASD in relation to their stress and health has not been developed, particularly one using a video conferencing platform  A video conferencing platform offers the opportunity to unite parents across the United States and enables participation because of scheduling flexibility

Study Background  This pilot study examines the feasibility and acceptability of the Stress Management And Resiliency Training-Relaxation Response Resiliency Program (SMART-3RP) program for parents of children with LADs or ASD  9-session 1.5 hour/week virtual SMART-3RP adapted using focus group interviews with parents and professionals  Seeks to decrease distress and increase resiliency, stress coping, social support, and mindfulness in parents of children with LAD or ASD across the United States.

SMART-3RP Intervention Curriculum

Study Methods  Design: Randomized, waitlist controlled pilot trial (09/2016-04/2017)  Participants: Parents of children with LADs and or children with ASD  Procedure:  Immediate vs. waitlist intervention (control group)  Self-report measures collected at: baseline (T1), at 3 months (T2), and at 6 months (T3)  Immediate group received virtual SMART-3RP intervention from T1 to T2 with no active intervention from T2 toT3.  Waitlist arm received the intervention from T2 to T3.

Outcome Measures  Primary outcome measures:  Distress (Visual Analog Scale; primary [VAS])  Resiliency (Current Experiences Scale [CES])  Secondary outcome measures:  Stress coping (Measure of Current Status part A [MOCS-A])  Social support (Medical Outcome social support survey [MOS])  Mindfulness (Cognitive and Affective Mindfulness Scale – Revised [CAMS-R]).

Analyses  For immediate treatment subjects, we assessed feasibility and acceptability by examining attendance and responses to a feedback form.  Pre-post change from T1 to T2, controlling for sociodemographic baseline characteristics.

Results: Demographics Enrollment by U.S. Region Parents of Children with LAD Parents of Children with ASD

Results: Feasibility and Acceptability  LAD Study:  43.9% enrolled and were randomized to the immediate (n=31) or waitlist (n=23) condition.  In response to the question, “How successfully do you think this treatment will reduce your stress- related symptoms” (1=not at all to 9=very), intervention participants responded on average 7.1 (SD=1.9)  70.4% of intervention participants completed 6 sessions or more.  81% reported practicing relaxation response exercises at least weekly.

Results: Feasibility and Acceptability  ASD Study:  56.7% enrolled and were randomized to the immediate (n=25) or waitlist (n=26) condition.  65% of intervention participants completed 6 sessions or more  83% reported practicing relaxation response exercises at least a few times a week  In response to the question, “How successfully do you think this treatment will reduce your stress- related symptoms” (1=not at all to 9=very), intervention participants responded on average 6.7 (SD=1.8)

LAD Study Results: T1-T2 comparisons  Among intervention participants, improvements were reported on distress, resiliency (CES), mindfulness (CAMS-R), and stress coping (MOCS-A) (all ps<.05).  Significant improvements in primary outcomes: distress (VAS; p=.05), and resiliency (CES; p=.01)  Significant improvements in secondary outcomes: mindfulness (CAMS-R; p= .01) and stress coping (MOCS-A; p=.001), but not in social support.

LAD Study Results: T2-T3 comparisons  Maintenance effects were observed in the immediate treatment group from T2 to T3 in resiliency (CES), stress coping (MOCS-A), social support (MOS), and mindfulness (CAMS-R).

ASD Study Results: T1-T2 comparisons  Immediate treatment group showed greater improvement in resiliency relative to the delayed treatment group, (CES; p=.038).  The immediate treatment group showed a small improvement in distress (VAS) relative to the delayed treatment group, although these differences did not reach statistical significance (p=.23).  Immediate treatment participants showed improvements in stress coping (MOCS-A; p=.001), social support (MOS; p=.04) and mindfulness (CAMS-R; p=.018).

ASD Study Results: T2-T3 comparisons  Maintenance effects were observed in the immediate treatment group from T2 to T3 in resiliency (CES), stress coping (MOCS-A), social support (MOS), and mindfulness (CAMS-R).

Conclusions  Pilot trial findings show promising feasibility, acceptability, and efficacy  Virtually- delivered resiliency treatment improved parents’ overall levels of distress, stress coping, and resiliency.  Video conferencing-based interventions may help to better reach, and connect, parents of children with LADs or ASD who may otherwise be difficult to engage in programs due to the demands of caregiving  Post-treatment improvements in psychosocial outcomes were sustained at T3 (6 months post-enrollment)

Next Steps: Your Input  Gathering input/feedback on study results  Ideas for implementation trial (e.g., clinician or peer delivered)  Identifying funders  Identifying organizational partners, particularly for parent referrals